life support

Life Support

Definition

Life support refers to a spectrum of techniques used to maintain life after the failure of one or more vital organs.

Purpose

A patient requires life support when one or more vital organs fail, due to causes such as trauma, infection, cancer, heart attack, or chronic disease. Among the purposes of life support are to:

Establish and maintain the ABC's of resuscitation—airway, breathing, and circulation.

Restore the patient's homeostasis—the internal chemical and physical balance of the body.

Protect the patient from complications of the underlying disease and its treatment.

Precautions

Patients and families need to recognize that life support is an extremely painful, expensive, and emotionally wrenching experience. Life support exposes a patient to vast risks of further medical complications, and offers no guarantee of a positive outcome. Even in successful cases, recovery may be slow and frustrating.

Description

Successful life support begins with establishing the ABC's of resuscitation—airway, breathing, and circulation.

The airway refers to a clear passageway for air to enter the lungs from outside the body. The patient's airway may become blocked by:

Life support may begin with basic cardiopulmonary resuscitation (CPR), as in cases of cardiac arrest. Thereafter, the most common technique used to create a secure airway is insertion of an endotracheal (ET) tube through the mouth or nose into the windpipe (trachea). An alternative method of securing an airway is by tracheotomy, a surgical procedure in which a tube is inserted into the trachea through an incision made in the base of the throat. Of the two options, placement of an ET tube is usually quicker and more convenient, and thus occurs much more commonly. Doctors perform a tracheotomy when they cannot establish an ET airway, or when the patient will require an artificial airway for more than a week or two.

Breathing refers to the movement of air in and out of the lungs. Inadequate breathing may result from:

When the patient cannot breathe sufficiently, the physician will use a ventilator, a machine that pumps air in and out of the patient's lungs. For many doctors and members of the public, the term "life support" calls up the image of an ET tube and ventilator.

Circulation refers to the flow of blood around the body from the heart to vital organs. Circulation can fail due to:

Primary disease of the heart (heart attack)

Blood loss (trauma or internal bleeding of any cause)

Severe infection (sepsis)

Drug reactions or overdoses

Extreme allergic reaction

Severe dehydration (gastroenteritis or heat-related illness)

In order to ensure adequate circulation, the patient will require one or more intravenous (IV) tubes (catheters). The IVs may include both the short needle and tube commonly used in the hand or forearm, and longer catheters inserted into the larger and more central veins of the body. Catheters inserted into these larger veins are known as central lines. Through the IVs the patient receives fluids, drugs, and blood transfusions as needed to support the circulation.

Once the ABC's are secure, life support is directed at maintaining homeostasis, the body's delicate chemical and physical balance. In a healthy person, the body keeps precise control over many components of its makeup, such as its fluids, nutrients, and pressures. When vital organs fail, the body can no longer regulate these components, and the doctor must take steps to restore the normal state.

Sedation or even temporary paralysis to enable the patient to tolerate these procedures

Preparation

The need for life support may arise suddenly and with little warning. All people should discuss in advance with family and doctor their wishes for the use of life support should a medical crisis develop. The doctor will note the preferences in the patient's record. Patients should sign documents such as an Advance Directive and Durable Power of Attorney for Health Care to express their wishes and designate a surrogate decision-maker in case of incapacitation.

Physicians and medical care providers must anticipate the possibility that a patient will require life support, perhaps suddenly. In preparation, doctors and medical staff must:

Receive training in resuscitation skills

Monitor patients carefully

Maintain proper supplies and equipment

Discuss in advance with patients and patients' families whether or not to begin life support

Aftercare

If a patient survives life support treatments, doctors will cautiously try to wean the patient from the support systems. Being able to breathe adequately without the ventilator is one major hurdle. Patients commonly fail in their first attempts to breathe on their own, often tiring out after a few hours. Thus, the doctor will reconnect the ventilator, give the patient a rest, and try again in a day or two.

As the patient regains organ function, there is less need for monitors, tests, and treatments that require an intensive care setting. The doctor may transfer the patient to a lower level of hospital care, a skilled nursing facility (SNF), or perhaps directly to home. Physical and occupational therapists may help the patient improve strength and endurance. The patient will receive continuing care from the primary doctor and specialists as needed. The patient may require prescription drugs, assist devices, and psychological therapists.

Risks

The risks and consequences of life support are enormous. These risks include:

Physical dangers

Emotional suffering

Financial costs

Societal discord

The physical dangers of life support encompass all the hazards of the patient's underlying disease and treatments. Among these risks are:

Permanent damage to the brain, kidneys, and other vital organs caused by poor circulation or low oxygen content of the blood

Direct damage to organs from use of medical instruments and procedures

Infections, often with organisms that are highly resistant to antibiotics

Abnormal blood clots

Skin ulcers from lying immobilized for long periods

Extreme pain

Exposure of medical personnel to communicable diseases

The emotional consequences of life support touch patients, families, and medical caregivers. These repercussions arise from:

The frightening environment of an ICU

The need to make life-and-death decisions

The anger, guilt, and grief that relate to life-threatening illness

The fact that many lengthy and difficult treatments will end in failure

The financial costs of life support are huge. A single day of life support costs many thousands of dollars. These expenses fall on individual payers, insurance companies, health plans, and governments. All such payers face difficult decisions regarding the allotment of money for such treatment, especially in cases that are likely to be futile.

Society as a whole faces difficult decisions surrounding life support. Some governments have enacted regulations that establish priorities for the spending of health care resources. Patients who do not receive treatment under such rules may feel victimized by society's choices.

life support

life support

the use of any therapeutic technique, device, or technology to maintain physical life functions.

life support

Any technique, therapy, or device that assists in sustaining life.

ADVANCED CARDIAC LIFE SUPPORT: Mannequin used for training

advanced cardiac life support

Abbreviation: ACLS

ADVANCED CARDIAC LIFE SUPPORT: Mannequin used for training

1. The resuscitation of dying patients. ACLS involves management of the airway, reestablishment of breathing, and the restoration of spontaneous heart rhythm, blood pressure, and organ perfusion. It begins with the recognition of cardiac or respiratory emergencies, and includes cardiopulmonary resuscitation, defibrillation, endotracheal intubation, oxygenation and ventilation, medications for restoring normal cardiac rhythms and cardiac output, cardiac pacing (when needed), and post-resuscitation care. It may begin in the out-of-hospital setting or take place in the hospital. See: illustration

Advanced Medical Life Support

advanced trauma life support

basic cardiac life support

Abbreviation: BCLS

The phase of cardiopulmonary resuscitation (CPR) and emergency cardiac care that either (1) prevents circulatory or respiratory arrest or insufficiency by prompt recognition and early intervention or by early entry into the emergency care system or both; or (2) externally supports the circulation and respiration of a patient in cardiac arrest through CPR. When cardiac or respiratory arrest occurs, basic life support (BLS) should be initiated by anyone present who is familiar with CPR.

Dr Roberts and Welsh Hearts will be visiting schools and spend about an hour running the session in the hope that by teaching it in this manner it will provide a more thorough understanding of basic life support and may even stimulate an interest in medicine among the students.

Out of the total number ( n=110) of doctors, 94 (85%) said they would use Life Support in their patients and 41 (43%) of them thought life support was the only way the doctor can "do what he is supposed to do i.

Among these areas are First Aid, Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), Advanced Trauma Life Support (ATLS), the Pediatric Advanced Life Support for children (PALS), Focused Abdominal Sonogram for Trauma (FAST), Advanced Life Support in Obstetrics (ALSO), Major Incident Medical Management and Support (MIMMS), Advanced Disaster Administration and Management Support (ADAM) and others.

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